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McLoughlin C, McWhirter L, Pisegna K, Tijssen MAJ, Tak LM, Carson A, Stone J. Stigma in functional neurological disorder (FND) - A systematic review. Clin Psychol Rev 2024; 112:102460. [PMID: 38905960 DOI: 10.1016/j.cpr.2024.102460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 05/10/2024] [Accepted: 06/10/2024] [Indexed: 06/23/2024]
Abstract
OBJECTIVE The purpose of this systematic review was to evaluate stigma and Functional Neurological Disorder (FND) regarding: 1) prevalence and associated factors, 2) the nature and context of stigma in FND, and 3) stigma-reduction interventions. METHODS We searched four relevant databases from inception to December 2023, using search terms relevant to FND and stigma themes. We employed the method of synthesis by "aggregation and configuration" to synthesise and analyse the data into emergent themes. RESULTS We found 127 studies, spanning 148 countries, involving 18,886 participants. Of these, 4889 were patients, 13,123 were healthcare professionals, and 526 were caregivers. Quantitatively, stigma has been mainly studied in patients with functional seizures, and was higher than patients with epilepsy in three studies. Stigma experienced by patients is associated with poorer quality of life and caregiver burden. We found 10 themes and 29 subthemes revealing stigma as a systemic process, with intrapersonal, interpersonal and structural aspects. Few studies examined the perspective of caregivers, the public or online community. We identified six anti-stigma interventions. CONCLUSION Stigma in FND is a layered process, and affects patient quality of life and provision of care. Stigma needs to be addressed from the top structures, at governmental level, so that appropriate care pathways can be created, giving patients with FND parity of esteem with other medical conditions.
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Affiliation(s)
- Caoimhe McLoughlin
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom.
| | - Laura McWhirter
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | | | - Marina A J Tijssen
- UMCG Expertise Centre Movement Disorders Groningen, University of Groningen, Groningen, the Netherlands
| | - Lineke M Tak
- Dimence Alkura, Specialist center Persistent Somatic Symptoms, Nico Bolkensteinlaan 65, 7416 SE Deventer, the Netherlands
| | - Alan Carson
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Jon Stone
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
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Underwood R, Falshaw L, McFarlane F. Psychoeducation interventions for people with non-epileptic seizures: A scoping review. Seizure 2024; 120:15-24. [PMID: 38889520 DOI: 10.1016/j.seizure.2024.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 05/20/2024] [Accepted: 05/22/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND Cognitive behavioural therapy (CBT) and other psychological approaches have a growing evidence base for treating Non-Epileptic Seizures (NES). However, communication about the diagnosis can be difficult for clinicians and is not always well received. It is thought that Psychoeducation about NES may improve engagement with treatment such as CBT and may contribute to reductions in the frequency of seizures and improvements in health related quality of life. However, psychoeducational components of treatment are often not evaluated in isolation meaning the specific benefit to patients is not currently well understood. AIMS The researchers aimed to examine the outcomes associated with psychoeducational interventions and the content of these programmes for NES. METHOD A scoping review was undertaken across four databases with seventeen eligible studies identified which were charted to analyse the data. RESULTS Findings revealed that components and modalities of interventions varied as did methods of evaluating the interventions. A number of different outcome measures were used and not all studies reported the significance of findings. Results across studies were inconsistent; however, there was a general trend across the studies of symptom reduction and improvement in mental health. CONCLUSIONS Findings illustrate that psychoeducation has potential benefits as an intervention in its own right. However, it may be best placed as a second step in a stepped care model, between initial diagnosis and further psychological treatment. The present literature needs replication and more robust studies for more certain conclusions to be drawn.
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Affiliation(s)
- Rebecca Underwood
- Clinical Psychologist, The Oxford Institute for Clinical Psychology Training and Research, The Isis Education Centre, Warneford Hospital, Oxford, OX3 7JX, UK
| | - Lawson Falshaw
- Clinical Psychologist, The Oxford Institute for Clinical Psychology Training and Research, The Isis Education Centre, Warneford Hospital, Oxford, OX3 7JX, UK
| | - Fiona McFarlane
- Clinical Psychologist, The Oxford Institute for Clinical Psychology Training and Research, The Isis Education Centre, Warneford Hospital, Oxford, OX3 7JX, UK.
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Zeun D, Hunter H. Physiotherapy management of functional movement disorders: the patient perspective. Disabil Rehabil 2023:1-9. [PMID: 37876224 DOI: 10.1080/09638288.2023.2272709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 10/14/2023] [Indexed: 10/26/2023]
Abstract
PURPOSE People with functional movement disorders (FMD) are commonly seen in neurology clinics. Despite a recent increase in research, no standardised treatment pathway across the UK exists. Currently only a few qualitative studies in FMD with a focus on psychological aspects and diagnosis have been published. This study aimed to understand people with FMD perceptions of their physiotherapy treatment. METHOD Qualitative web-based interviews were conducted with seven participants and an interpretive phenomenological approach was used to identify themes from the data. RESULTS Four themes were identified; 1) my brain, mind and body are all me, 2) physiotherapy; what helps and what doesn't, 3) what recovery is to me, and 4) barriers to treatment. Participants desired a combination of psychological and physical approaches, which were holistic, individualised, and delivered by experienced physiotherapists. Limited availability and funding of specialist treatments were barriers to recovery. CONCLUSION Holistic management combining psychological and physiological systems seems to be crucial for effective management of FMD. Large variations in physiotherapy treatment exist across the UK. It is hoped that increasing the understanding, amongst healthcare professionals will lead to the development of timely and appropriate pathways for patients that otherwise find themselves lost between medical specialities.IMPLICATIONS FOR REHABILITATIONPatients report more positive experiences when a combined and detailed psychological and physiological explanation to their symptoms is given.An individualised approach working with the patient on activities they find challenging is more preferable than group exercise or impairment based (e.g., strengthening/stretching) treatments.Having a physiotherapist who is experienced in treating functional movement disorders or prepared to learn and understand them helped with adherence to treatment.
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Affiliation(s)
- Debbie Zeun
- Department of Physiotherapy, School of Health Professions, University of Plymouth, Plymouth, UK
| | - Heather Hunter
- Department of Physiotherapy, School of Health Professions, University of Plymouth, Plymouth, UK
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Coey P, Nic Craith I, McQuaid L, D'Alton P, O'Connor C. Does explaining psychogenic nonepileptic seizures using either a biomedical or biopsychosocial framework affect young people's illness representations? An experimental vignette study. Epilepsy Behav 2023; 142:109186. [PMID: 37028150 DOI: 10.1016/j.yebeh.2023.109186] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 03/16/2023] [Accepted: 03/16/2023] [Indexed: 04/09/2023]
Abstract
Lay representations of psychogenic nonepileptic seizures (PNES) are important both for understanding public stigma and anticipating patient responses to PNES diagnosis. The current study presents the first evidence of the general public's representations of PNES and the malleability of these understandings to different ways of explaining PNES. An online experimental study exposed participants (n = 193, aged 18-25 years) to a vignette describing a case of PNES in biomedical terms, PNES in biopsychosocial terms, or epilepsy. Subsequent questionnaires assessed participants' illness representations, causal attributions, and stigmatising attitudes regarding the case about which they read. Results suggest that compared with biomedical framings, biopsychosocial explanations increased perceptions of PNES as threatening. While epilepsy was attributed to significantly more biological and less social causes than either of the PNES vignettes, causal attributions did not differ between biomedically- vs. biopsychosocially-framed PNES. Neither were there any differences between the three conditions in stigmatising attitudes towards people who experience seizures. These findings are useful for clinicians delivering a PNES diagnosis and patients disclosing a PNES diagnosis, in helping anticipate responses to these communications. Further research is required to confirm the clinical and societal significance of the study's first insights into the dynamics of lay responses to PNES.
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Affiliation(s)
- Phillip Coey
- Paediatric Psychology Department, Children's Health Ireland at Crumlin, Dublin 12, Ireland; School of Psychology, Trinity College Dublin, Dublin 2, Ireland
| | | | - Léa McQuaid
- School of Psychology, University College Dublin, Dublin 4, Ireland
| | - Paul D'Alton
- School of Psychology, University College Dublin, Dublin 4, Ireland; Psychology Department, St. Vincent's University Hospital, Dublin 4, Ireland
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María Marta AP, Mercedes S, Alejandra Inés L, Cristina T, Camila W, Luciana DA, Guido Pablo K. Cultural issues: Perspectives and experiences of patients with dissociative seizures in Argentina. Seizure 2023; 106:101-109. [PMID: 36812680 DOI: 10.1016/j.seizure.2023.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 02/02/2023] [Accepted: 02/09/2023] [Indexed: 02/15/2023] Open
Abstract
PURPOSE To explore patients' subjective experience when receiving a diagnosis of Dissociative Seizures (DS) in Buenos Aires, Argentina, and their explanatory models about DS. METHOD A qualitative approach using semi-structured interviews was used to gain an in-depth and contextual understanding of the perspectives of 19 patients with DS. Data collection and analysis were followed by an inductive and interpretive approach informed by the principles of thematic analysis. RESULTS Four main themes emerged: 1) Reactions to the Diagnosis; 2) Ways of Naming the Disease; 3) Own Explanatory Models; 4) External Explanatory Models. CONCLUSIONS This information might help achieve an adequate knowledge of the local characteristics of patients with DS. Most patients could not express any emotions or considerations about being diagnosed with DS, and they related their seizures to a personal or social-emotional conflict and environmental stress; however, family members related patients' seizures to a biological cause. It is important to analyze cultural differences in patients with DS in order to develop appropriate interventions for this specific population.
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Affiliation(s)
- Areco Pico María Marta
- Buenos Aires University, Psychology School, Psychology School Research Institute National Council for Scientific and Technical Research (CONICET), Lavalle 2353 C1052AAA, Buenos Aires, Argentina.
| | - Sarudiansky Mercedes
- Buenos Aires University, Psychology School, Psychology School Research Institute National Council for Scientific and Technical Research (CONICET), Lavalle 2353 C1052AAA, Buenos Aires, Argentina
| | - Lanzillotti Alejandra Inés
- Buenos Aires University, Psychology School, Psychology School Research Institute National Council for Scientific and Technical Research (CONICET), Lavalle 2353 C1052AAA, Buenos Aires, Argentina
| | - Tenreyro Cristina
- Buenos Aires University, Psychology School, Psychology School Research Institute National Council for Scientific and Technical Research (CONICET), Lavalle 2353 C1052AAA, Buenos Aires, Argentina
| | - Wolfzun Camila
- Buenos Aires University, Psychology School, Psychology School Research Institute National Council for Scientific and Technical Research (CONICET), Lavalle 2353 C1052AAA, Buenos Aires, Argentina
| | - D' Alessio Luciana
- Buenos Aires University, Psychology School, Psychology School Research Institute National Council for Scientific and Technical Research (CONICET), Lavalle 2353 C1052AAA, Buenos Aires, Argentina; Buenos Aires University, Ramos Mejía Hospital, Epilepsy Center, Gral. Urquiza 609, C1221ADC, Buenos Aires, Argentina; Buenos Aires University, Medicine School, Cell Biology and Neuroscience Institute (IBCN)- National Council for Scientific and Technical Research (CONICET), Paraguay 2155, C1121 ABG, Buenos Aires, Argentina
| | - Korman Guido Pablo
- Buenos Aires University, Psychology School, Psychology School Research Institute National Council for Scientific and Technical Research (CONICET), Lavalle 2353 C1052AAA, Buenos Aires, Argentina
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Leroy A, Tarrada A, Garcin B, Hingray C. Crisi psicogene non epilettiche (funzionali/dissociative). Neurologia 2023. [DOI: 10.1016/s1634-7072(22)47362-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
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Varley D, Sweetman J, Brabyn S, Lagos D, van der Feltz-Cornelis C. The clinical management of functional neurological disorder: A scoping review of the literature. J Psychosom Res 2023; 165:111121. [PMID: 36549074 DOI: 10.1016/j.jpsychores.2022.111121] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 12/13/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To date, there have been no reviews bringing together evidence on the clinical management of functional neurological disorder (FND) and patients', caregivers', and healthcare workers' experiences. This review provides an overview of the literature focused on the clinical management of FND. METHODS Four databases were searched, and a consultation exercise was conducted to retrieve relevant records dated from September 2010 to September 2020. Articles documenting diagnostic methods, treatments or interventions, or the experiences and perspectives of patients and healthcare workers in the clinical management of FND were included. RESULTS In total, 2756 records were retrieved, with 162 included in this review. The diagnostic methods reported predominantly included positive clinical signs, v-EEG and EEG. Psychological treatments and medication were the most reported treatments. Mixed findings of the effectiveness of CBT were found. Haloperidol, physiotherapy and scripted diagnosis were found to be effective in reducing FND symptoms. Several facilitators and barriers for patients accessing treatment for FND were reported. CONCLUSION The literature describing the clinical management for FND has increased considerably in recent times. A wide variety of diagnostic tools and treatments and interventions were found, with more focus being placed on tests that confirm a diagnosis than 'rule-out' tests. The main treatment type found in this review was medication. This review revealed that there is a lack of high-quality evidence and reflects the need for official clinical guidelines for FND, providing healthcare workers and patients the support needed to navigate the process to diagnose and manage FND.
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Affiliation(s)
- Danielle Varley
- Department of Health Sciences, University of York, York YO10 5DD, UK.
| | - Jennifer Sweetman
- Department of Health Sciences, University of York, York YO10 5DD, UK
| | - Sally Brabyn
- Department of Health Sciences, University of York, York YO10 5DD, UK
| | - Dimitris Lagos
- Hull York Medical School, University of York, York YO10 5DD, UK
| | - Christina van der Feltz-Cornelis
- Department of Health Sciences, University of York, York YO10 5DD, UK; Hull York Medical School, University of York, York YO10 5DD, UK; York Biomedical Research Institute, University of York, York YO10 5DD, UK; Institute of Health Informatics, University College London, London NW1 2DA, UK
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Gurcan L, McAllister E, Gilmour J, Green DJ, McFarlane FA, Hadji-Michael M, Heyman I, Stark D. Improved understanding of non-epileptic seizures and reduced emergency health care usage following a single psychoeducational group for children and their parents. Seizure 2022; 101:1-7. [PMID: 35841833 DOI: 10.1016/j.seizure.2022.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 06/27/2022] [Accepted: 07/01/2022] [Indexed: 11/17/2022] Open
Abstract
RATIONALE The aim of this study was to evaluate the effectiveness of a three-hour psychoeducation group in improving understanding of non-epileptic seizures (NES), health outcomes and quality of life in young people with NES. BACKGROUND Multi-session psychoeducational groups for adults with NES have reported improved psychosocial functioning and reduced NES compared to those who do not receive psychoeducational interventions. To date there have been no studies in young people examining the effects of a single session of psychoeducation. METHOD 15 young people with NES and their families attended a psychoeducation group within a specialist hospital following a multidisciplinary assessment. The group's effectiveness was evaluated in terms of perceptions of seizure controllability, seizure severity, the management of the condition and health-related quality of life measures. RESULTS A significant decrease in accident and emergency (A&E) visits and ambulance call outs was observed following the psychoeducation group. Young people additionally reported increased knowledge of NES and ability to cope with the condition which was maintained at 6-week follow-up. Significant reduction in NES occurrence or quality of life was not observed. CONCLUSION Significant reduction in A&E attendance and ambulance use was found following group psychoeducation and improvements in psychosocial functioning and knowledge about NES. Group psychoeducation has the potential to increase child and parental understanding of NES and reduce inappropriate healthcare usage.
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Affiliation(s)
- Lara Gurcan
- Great Ormond Street Hospital NHS Foundation Trust, United Kingdom; University College London, United Kingdom
| | - Eve McAllister
- Great Ormond Street Hospital NHS Foundation Trust, United Kingdom; University College London, United Kingdom
| | - Jane Gilmour
- Great Ormond Street Hospital NHS Foundation Trust, United Kingdom; University College London, United Kingdom
| | | | - Fiona A McFarlane
- Great Ormond Street Hospital NHS Foundation Trust, United Kingdom; University College London, United Kingdom
| | - Maria Hadji-Michael
- Great Ormond Street Hospital NHS Foundation Trust, United Kingdom; University College London, United Kingdom
| | - Isobel Heyman
- Great Ormond Street Hospital NHS Foundation Trust, United Kingdom; University College London, United Kingdom.
| | - Daniel Stark
- Great Ormond Street Hospital NHS Foundation Trust, United Kingdom; University College London, United Kingdom
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Functional seizures: The patient’s perspective of a diagnostic and treatment odyssey. Epilepsy Behav Rep 2022; 17:100509. [PMID: 35112075 PMCID: PMC8790607 DOI: 10.1016/j.ebr.2021.100509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 11/16/2021] [Accepted: 11/21/2021] [Indexed: 11/22/2022] Open
Abstract
Functional seizures remains a complex neuropsychiatric condition to identify and treat. Practitioners must address management of physical symptoms and underlying causes. Management strategies can fail if their reasoning is not properly communicated. Better outcomes may result where treatment rationale is emphasized from outset.
Functional seizures can be challenging to properly diagnose, often leading to delays in treatment. The etiology of functional seizures is multifactorial, with psychological factors identified in many, but not all cases. Misdiagnosis may occur due to clinical features mimicking other medical conditions. Once a correct diagnosis is reached, delivery of definitive, evidence-based treatment may be challenging due to limited availability of specialized resources. Research shows psychological education and cognitive behavioral therapy (CBT) have the greatest efficacy. However, individual differences, including acceptance of the diagnosis, therapeutic alliance, duration of symptoms, comorbidities, and access to care may influence outcomes. There is a critical need for reports that can help identify barriers to effective diagnosis and treatment. We present the diagnosis and treatment of a woman who visited the emergency room after an attack of predominant left-sided paralysis, speech dysfunction and altered awareness. Following multiple daily episodes and visits to multiple medical practitioners, testing led to a diagnosis of functional seizures. While the patient was recommended to undergo a variety of therapeutic interventions, including CBT, she ultimately terminated treatment. In a subsequent interview, the patient revealed her personal experience with perceived limitations of acute management strategies. We explore the complexities of diagnosing and treating individuals with functional seizures.
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Read J, Jordan H, Perdue I, Purnell J, Murray J, Chalder T, Reuber M, Stone J, Goldstein LH. The experience of trial participation, treatment approaches and perceptions of change among participants with dissociative seizures within the CODES randomized controlled trial: A qualitative study. Epilepsy Behav 2020; 111:107230. [PMID: 32640411 PMCID: PMC7581898 DOI: 10.1016/j.yebeh.2020.107230] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 05/17/2020] [Accepted: 06/05/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Nested within a large, multicenter randomized controlled trial (RCT) for people with dissociative seizures (DS), the study used purposive sampling to explore participants' experience of participating in an RCT, their experience of DS-specific cognitive behavioral therapy (CBT) and another component of the RCT, Standardized Medical Care (SMC) and their perceptions of and reflections on seizure management and change. METHODS A qualitative study using semistructured interviews was conducted with 30 participants in an RCT (the COgnitive behavioral therapy vs standardized medical care for adults with Dissociative non-Epileptic Seizures (CODES) Trial) investigating the effectiveness of two treatments for DS. Key themes and subthemes were identified using thematic framework analysis (TFA). RESULTS Analysis yielded three overarching themes: taking part in a treatment trial - "the only thing out there", the experience of treatment techniques that were perceived to help with seizure management, and reflections on an "unpredictable recovery". CONCLUSIONS People with DS are amenable to participating in a psychotherapy RCT and described a largely positive experience. They also described the applicability of aspects of DS-specific CBT and SMC in the management of their DS, received within the confines of the CODES trial. Factors that appeared to account for the variability in response to treatment delivery included individual preferences for the nature of sessions, the nature of therapeutic relationships, readiness to discuss trauma, other aspects of emotional avoidance, and whether therapy provided something new.
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Affiliation(s)
- Julie Read
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Harriet Jordan
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Iain Perdue
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - James Purnell
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Joanna Murray
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Trudie Chalder
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Markus Reuber
- Academic Neurology Unit, University of Sheffield, Royal Hallamshire Hospital, Sheffield S10 2JF, UK
| | - Jon Stone
- Department of Clinical Neuroscience, Centre for Clinical Brain Sciences, University of Edinburgh, UK
| | - Laura H Goldstein
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK.
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Loewenberger A, Cope SR, Poole N, Agrawal N. An investigation into the preferred terminology for functional seizures. Epilepsy Behav 2020; 111:107183. [PMID: 32535370 DOI: 10.1016/j.yebeh.2020.107183] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 04/15/2020] [Accepted: 04/15/2020] [Indexed: 11/27/2022]
Abstract
There is considerable debate in the literature regarding what to call functional seizures, with terms such as pseudoseizures, nonepileptic attack disorder (NEAD), and dissociative seizures being used. Provision of an accurate diagnosis and coherent explanation is a vital first step in the management of functional seizures and can result in cessation or reduced frequency for some individuals. This study investigated preferences for and offensiveness of terms used to describe functional seizures, and expectations for recovery with psychological treatment. A sample of 87 healthy adults completed an online survey, in which eight different diagnostic terms were ranked in order of preference (1 - most preferred, 8 - least preferred): functional nonepileptic attacks (FNEA), dissociative seizures, functional seizures, psychogenic seizures, NEAD, pseudoseizures, conversion disorder, and hysteria. Replicating Stone and colleagues protocol, each term was investigated for five connotations. Offense scores were calculated from the number of participants who selected 'yes' to at least one of the negative connotations ('Putting it on', 'Mad', and 'Imagining Symptoms'). Expectations about the possibility of recovering through medical or psychological treatment were also recorded. Functional nonepileptic attack was ranked the highest preferred term with dissociative seizures and functional seizures closely following. Nonepileptic attack disorder was the least offensive term, with FNEA and functional seizures joint second. Unsurprisingly, the three least preferred terms were also the most offensive: pseudoseizures, conversion disorder, and hysteria. Expectations of nonrecovery from psychological treatment were lowest for terms implicating a psychological cause: pseudoseizures, dissociative seizures, psychogenic seizures, and hysteria. The results suggest that either the terms FNEA or functional seizures should be adopted by healthcare professionals and patients, as they are the most preferred, least offensive, and expectations for nonrecovery with psychological treatment were moderate compared with the other terms. Limitations and areas for future research are discussed.
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Affiliation(s)
- Alana Loewenberger
- University College London, Chandler House, 2 Wakefield Street, London, United Kingdom of Great Britain and Northern Ireland.
| | - Sarah R Cope
- Neuropsychiatry Service, St. George's Hospital, Blackshaw Road, London SW17 0QT, United Kingdom of Great Britain and Northern Ireland
| | - Norman Poole
- Neuropsychiatry Service, St. George's Hospital, Blackshaw Road, London SW17 0QT, United Kingdom of Great Britain and Northern Ireland
| | - Niruj Agrawal
- Neuropsychiatry Service, St. George's Hospital, Blackshaw Road, London SW17 0QT, United Kingdom of Great Britain and Northern Ireland
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12
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Oto M, Reuber M. Psychogenic non-epileptic seizures: aetiology, diagnosis and management. ACTA ACUST UNITED AC 2018. [DOI: 10.1192/apt.bp.113.011171] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
SummaryPsychogenic non-epileptic seizures (PNES) have a significant impact on most patients in terms of distress, disability, loss of income and iatrogenic harm. Three-quarters of patients with PNES are initially misdiagnosed and treated for epilepsy. Misdiagnosis exposes patients to multiple iatrogenic harms and prevents them from accessing psychological treatment. In most cases, the patient's history (and witness accounts) should alert clinicians to the likely diagnosis of PNES. Since this diagnosis may be resisted by patients and may involve ‘un-diagnosing’ epilepsy, video-electroencephalogram recording of typical seizures is often helpful. The underlying causes of PNES are diverse: a model combining predisposing, precipitating and perpetuating factors is a useful way of conceptualising their aetiology. The initial step of treatment should be to limit iatrogenic harm. There is some evidence for the effectiveness of psychotherapy.
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13
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Hill CE, Schwartz H, Dahodwala N, Litt B, Davis KA. Postdiagnosis neurological care for patients with psychogenic nonepileptic spells (PNES). Epilepsy Behav 2017; 74:64-68. [PMID: 28728045 PMCID: PMC5568679 DOI: 10.1016/j.yebeh.2017.06.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 06/19/2017] [Accepted: 06/19/2017] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This study investigated continuity of neurological care for patients discharged from the epilepsy monitoring unit (EMU) with a diagnosis of psychogenic nonepileptic spells (PNES). Because PNES are seizure-like episodes that cannot be explained by abnormal electrical brain activity, they are challenging for patients to understand and accept. Consequently, after diagnosis, patients commonly fail to start recommended psychotherapy and instead pursue redundant medical care. As consistent relationships with healthcare providers may help, we instituted standard follow-up for patients diagnosed with PNES. METHODS We performed a retrospective observational cohort study of adults diagnosed with PNES in our EMU. In November 2013, we began routine scheduling of postdischarge follow-up neurology appointments. We compared preintervention (November 2010-October 2013) and postintervention (November 2013-May 2016) cohorts with regard to clinic attendance, understanding the diagnosis, compliance with recommendations, and event frequency. RESULTS We identified 55 patients in the preintervention cohort and 123 patients in the postintervention cohort. We successfully implemented the intended practice changes; more patients had follow-up scheduled by discharge (preintervention 2% vs. postintervention 36%, p<0.001), time to follow-up decreased (46days vs. 29, p=0.001), and providers more consistently queried understanding of diagnosis (38% vs. 67%, p=0.03). Explicit planning for continued care did not produce the anticipated patient-provider relationships, as follow-up in clinic was low (38% vs. 37%). For patients who attended clinic, the intervention did not improve establishment of psychiatric care, compliance with medication recommendations, understanding of diagnosis, or event frequency. The odds of reduced event frequency were nonsignificantly increased with understanding the diagnosis (OR 3.75, p=0.14). Recommending antiepileptic drug (AED) discontinuation was associated with increased odds of event freedom (OR 6.91, p<0.01). SIGNIFICANCE Scheduling follow-up for patients diagnosed with PNES did not facilitate ongoing patient-provider relationships due to poor clinic attendance. As follow-up is unreliable, the inpatient visit is a critical window of opportunity for intervention.
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Affiliation(s)
- Chloe E. Hill
- Department of Neurology, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, United States
| | - Hannah Schwartz
- Department of Biology, Emory University, 201 Dowman Drive, Atlanta, GA 30322, United States
| | - Nabila Dahodwala
- Department of Neurology, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, United States
| | - Brian Litt
- Department of Neurology, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, United States
| | - Kathryn A. Davis
- Department of Neurology, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, United States
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14
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What patients say about living with psychogenic nonepileptic seizures: A systematic synthesis of qualitative studies. Seizure 2016; 41:100-11. [DOI: 10.1016/j.seizure.2016.07.014] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Revised: 07/12/2016] [Accepted: 07/15/2016] [Indexed: 11/23/2022] Open
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15
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De Toffol B, Biberon J, Hingray C, El-Hage W. Crisi non epilettiche psicogene (CNEP). Neurologia 2016. [DOI: 10.1016/s1634-7072(16)77533-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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16
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Hingray C, Biberon J, El-Hage W, de Toffol B. Psychogenic non-epileptic seizures (PNES). Rev Neurol (Paris) 2016; 172:263-9. [DOI: 10.1016/j.neurol.2015.12.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 12/23/2015] [Indexed: 10/21/2022]
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17
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Pick S, Mellers JDC, Goldstein LH. Emotion and dissociative seizures: A phenomenological analysis of patients' perspectives. Epilepsy Behav 2016; 56:5-14. [PMID: 26799918 DOI: 10.1016/j.yebeh.2015.12.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Revised: 12/02/2015] [Accepted: 12/09/2015] [Indexed: 10/22/2022]
Abstract
Quantitative research has indicated that patients with dissociative seizures (DS) show altered responses to emotional stimuli, in addition to considerable emotional distress and dysregulation. The present study sought to further explore emotional processes in this population, to extend previous findings, and to provide a phenomenological insight into patients' perspectives on these issues. Semistructured interviews were carried out with 15 patients with DS, and the principles of interpretative phenomenological analysis (IPA) were adopted in data analysis. Key themes elicited included: i) general emotional functioning; ii) adverse (stressful/traumatic) life experiences; iii) the role of emotions in DS; iv) relating to others; and v) resilience, protective factors, and coping mechanisms. The clinical and theoretical implications of the findings are discussed.
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Affiliation(s)
- Susannah Pick
- King's College London, Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, London SE5 8AF, UK.
| | - John D C Mellers
- Neuropsychiatry Department, Maudsley Hospital, South London and Maudsley NHS Foundation Trust, London SE5 8AZ, UK.
| | - Laura H Goldstein
- King's College London, Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, London SE5 8AF, UK.
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18
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Stone J, Carson A, Hallett M. Explanation as treatment for functional neurologic disorders. HANDBOOK OF CLINICAL NEUROLOGY 2016; 139:543-553. [PMID: 27719870 DOI: 10.1016/b978-0-12-801772-2.00044-8] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
There is widespread agreement that the way health professionals communicate the diagnosis of functional neurologic disorders (FND) has a central role in treatment, as it does arguably for most conditions. In this chapter we discuss barriers to effective diagnosis, different models of explanation and evidence regarding the importance of effective communication of the diagnosis in FND, especially movement disorders, and dissociative (nonepileptic) seizures. Debates and disagreements about how to go about this task often reflect different theoretic models held by health professionals rather than evidence. More evidence is required to know whether an initial emphasis on one model is more or less effective than another (e.g., a functional model vs. a psychologic model). We conclude, however, that there are a number of generic components to effective explanation shared by most authors on the topic that form the basis of a consensus. These include taking the patient seriously, giving the problem a diagnostic label, explaining the rationale for the diagnosis, some discussion of how the symptoms arise, emphasis on the potential for reversibility (rather than damage), and effective triage and referral for other treatment where appropriate. Although explanation can sometimes be therapeutic on its own, its role is probably more important as a facilitator to other therapy, including self-help, physical treatments, and psychotherapy.
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Affiliation(s)
- J Stone
- Department of Clinical Neurosciences, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.
| | - A Carson
- Departments of Clinical Neurosciences and of Rehabilitation Medicine, NHS Lothian and Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - M Hallett
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA
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19
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Karterud HN, Risør MB, Haavet OR. The impact of conveying the diagnosis when using a biopsychosocial approach: A qualitative study among adolescents and young adults with NES (non-epileptic seizures). Seizure 2015; 24:107-13. [PMID: 25458100 DOI: 10.1016/j.seizure.2014.09.006] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Revised: 09/22/2014] [Accepted: 09/24/2014] [Indexed: 11/26/2022] Open
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20
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The experience of adjusting to a diagnosis of non-epileptic attack disorder (NEAD) and the subsequent process of psychological therapy. Seizure 2014; 23:799-807. [DOI: 10.1016/j.seizure.2014.06.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Revised: 06/06/2014] [Accepted: 06/23/2014] [Indexed: 11/24/2022] Open
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21
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McMillan KK, Pugh MJ, Hamid H, Salinsky M, Pugh J, Noël PH, Finley EP, Leykum LK, Lanham HJ, LaFrance WC. Providers' perspectives on treating psychogenic nonepileptic seizures: frustration and hope. Epilepsy Behav 2014; 37:276-81. [PMID: 25128685 DOI: 10.1016/j.yebeh.2014.07.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Revised: 06/30/2014] [Accepted: 07/01/2014] [Indexed: 12/01/2022]
Abstract
Recent diagnostic and treatment advances in psychogenic nonepileptic seizures (PNES) have the potential to improve care for patients, but little is known about the current state of PNES care delivery in the Veterans Health Administration (VA). We conducted semistructured interviews with 74 health-care clinicians and workers in the VA, eliciting provider perceptions of PNES care. Data were analyzed according to principles of Grounded Theory. The results revealed variation in care and two emergent domain themes of frustration and hope. Frustration was manifest in subthemes including Complexity, Patient Acceptance, Uncertainty About Treatment, Need for Evidence-based Treatment, and Failure of Cross-Disciplinary Collaboration between neurologists and mental health providers. Hope encompassed subthemes of Positive Attitudes, Developing Cross-Disciplinary Treatment, and Specific PNES Care. Increased resources for diagnosing, treating, and researching PNES have improved awareness of the disorder. More research is needed to understand patients' and caregivers' perceptions of PNES care.
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Affiliation(s)
- Katharine K McMillan
- South Texas Veterans Health Care System, San Antonio, Texas University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.
| | - Mary Jo Pugh
- South Texas Veterans Health Care System and VA Epilepsy Centers of Excellence, San Antonio, TX University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Hamada Hamid
- VA Connecticut Healthcare System and VA Epilepsy Centers of Excellence, USA Yale University, New Haven, CT, USA
| | - Martin Salinsky
- Portland Veterans Affairs Medical Center and VA Epilepsy Centers of Excellence, Portland, Oregon Health & Sciences University, Portland, OR, USA
| | - Jacqueline Pugh
- South Texas Veterans Health Care System, San Antonio, Texas University of Texas Health Science Center at San Antonio, San Antonio, TX, USA; South Texas Veterans Health Care System, San Antonio, TX, USA
| | - Polly H Noël
- South Texas Veterans Health Care System, San Antonio, Texas University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Erin P Finley
- South Texas Veterans Health Care System, San Antonio, Texas University of Texas Health Science Center at San Antonio, San Antonio, TX, USA; Department of Medicine, and Department of Psychiatry, UT Health Science Center at San Antonio, San Antonio, TX USA
| | - Luci K Leykum
- South Texas Veterans Health Care System, San Antonio, Texas University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Holly J Lanham
- McCombs School of Business, University of Texas, Austin, TX USA
| | - W Curt LaFrance
- Providence Veterans Affairs Medical Center and Neuropsychiatry and Behavioral Neurology Division, Rhode Island Hospital, Brown University, Alpert Medical School, Providence, RI, USA
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23
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Understanding the perceived treatment needs of patients with psychogenic nonepileptic seizures. Epilepsy Behav 2014; 31:295-303. [PMID: 24239434 DOI: 10.1016/j.yebeh.2013.10.025] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Revised: 10/15/2013] [Accepted: 10/17/2013] [Indexed: 11/22/2022]
Abstract
Psychological therapy is generally considered the treatment of choice for psychogenic nonepileptic seizures (PNES), but there is a paucity of research on patients' attitudes towards psychological referral. We conducted semistructured interviews with twelve patients with PNES awaiting psychological treatment in order to understand their perceived treatment needs. Data were analyzed inductively according to the principles of thematic analysis. The results indicated that our patients had clear ideas about their treatment needs and a desire to recover by 'returning to normality'. Many participants felt 'caught in limbo' following their PNES diagnosis, however, because of uncertainties about their condition and a lack of support from professionals. This linked with participants feeling unsure whether psychological treatment would meet their needs; there was also apprehension for some participants about the potential negative consequences of therapy. The clinical implications of these findings are discussed, and recommendations for future research are made.
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24
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Sadjadi R, Quigg M. Simultaneous nonepileptic spells and nonorganic hearing loss: A case of comorbid psychogenic symptoms. EPILEPSY & BEHAVIOR CASE REPORTS 2014; 2:46-8. [PMID: 25667868 PMCID: PMC4307956 DOI: 10.1016/j.ebcr.2013.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Accepted: 12/17/2013] [Indexed: 11/30/2022]
Abstract
A twenty-eight-year-old woman with an eight-year history of partial hearing loss presented with a two-year history of worsening deafness and new-onset seizures. Evaluations of tympanic membranes, cochlea, and auditory brain stem reflexes demonstrated no physiologic basis for deafness. Video-EEG monitoring demonstrated that the patient responded normally to spontaneous auditory stimuli and that typical spells were nonepileptic in origin. Although pseudohypacusis is reported in audiology literature, and psychogenic nonepileptic spells are well-studied phenomena in neurology literature, the present case is an unusual case of dual psychogenic symptoms, a relationship that indicates poorer prognosis.
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Affiliation(s)
| | - Mark Quigg
- Corresponding author at: Box 800394, Dept. of Neurology, University of Virginia, Charlottesville, VA 22902, USA. Fax: + 1 434 982 1726.
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25
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Schmutz M. Dissociative seizures--a critical review and perspective. Epilepsy Behav 2013; 29:449-56. [PMID: 24090778 DOI: 10.1016/j.yebeh.2013.08.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2013] [Revised: 08/19/2013] [Accepted: 08/22/2013] [Indexed: 10/26/2022]
Abstract
Dissociative seizures are commonly recognized as both a challenging and a poorly understood condition. Though research and publication activity is high, advances in knowledge and insight seem only moderate in recent years. This review focuses on some relevant problematic issues, which might account for a still unsatisfactory research state. A general tendency to deal with dissociative seizures as an assumed disorder in its own nosological right and not as a sole symptom of an underlying psychiatric disorder is most likely one of the major roots of the problem. Unfavorable impacts of this confusion pertaining to clinical management, therapy, and outcome of dissociative seizures are discussed. An alternative point of view, based on the immanent psychiatric and psychodynamic roots of dissociative seizures, is considered.
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Affiliation(s)
- Matthias Schmutz
- Swiss Epilepsy Center, Dept. of Psychiatry/Psychotherapy, Bleulerstr. 60, CH-8008 Zurich, Switzerland.
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26
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A feasibility study of a brief psycho-educational intervention for psychogenic nonepileptic seizures. Seizure 2013; 22:760-5. [PMID: 23916276 DOI: 10.1016/j.seizure.2013.06.008] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Accepted: 06/09/2013] [Indexed: 11/19/2022] Open
Abstract
PURPOSE We have previously reported that one in six patients stops experiencing psychogenic nonepileptic seizures (PNES) following our communication protocol. This prospective multicentre study describes a psycho-educational intervention for PNES building on the initial communication of the diagnosis and examines the feasibility of its delivery by healthcare professionals with minimal experience in psychological therapies. METHOD Three healthcare professionals with minimal training in psychological therapies took part in a one-day training course. 20 participants attended for a four-session manualised psycho-educational intervention delivered at three different clinical neuroscience centres. Participants completed self-report measures prior to the intervention at baseline (n=29) and seven months after diagnosis (n=13) measures included seizure frequency, health related quality of life, healthcare utilisation, activity levels, symptom attributions and levels of functioning. Therapy sessions were audiorecorded and manual adherence assessed. RESULTS Of 29 patients enrolled into the study, 20 started and 13 completed the intervention and provided follow-up information. At follow-up, 4/13 of patients had achieved complete seizure control and a further 3/13 reported a greater than 50% improvement in seizure frequency. After training, epilepsy nurses and assistant psychologists demonstrated sufficient adherence to the manualised psycho-educational intervention in 80% of sessions. CONCLUSION The delivery of our brief manualised psycho-educational intervention for PNES by health professionals with minimal training in psychological treatment was feasible. The intervention was associated with higher rates of PNES cessation than those observed in our previous studies describing the short-term outcome of the communication of the diagnosis alone. An RCT of the intervention is justified but a significant proportion of drop-outs will have to be anticipated.
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27
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LaFrance WC, Reuber M, Goldstein LH. Management of psychogenic nonepileptic seizures. Epilepsia 2013; 54 Suppl 1:53-67. [DOI: 10.1111/epi.12106] [Citation(s) in RCA: 193] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- W. Curt LaFrance
- Neuropsychiatry and Behavioral Neurology Division; Rhode Island Hospital; Brown University, Alpert Medical School; Providence; Rhode Island; U.S.A
| | - Markus Reuber
- Academic Neurology Unit; Royal Hallamshire Hospital; University of Sheffield; Sheffield; United Kingdom
| | - Laura H. Goldstein
- Department of Psychology; Institute of Psychiatry; King's College London; London; United Kingdom
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28
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Whitehead K, Kandler R, Reuber M. Patients' and neurologists' perception of epilepsy and psychogenic nonepileptic seizures. Epilepsia 2013; 54:708-17. [DOI: 10.1111/epi.12087] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2012] [Indexed: 11/28/2022]
Affiliation(s)
| | - Rosalind Kandler
- Department of Clinical Neurophysiology; STH NHS Foundation Trust; Sheffield; United Kingdom
| | - Markus Reuber
- Academic Neurology Unit; University of Sheffield; Sheffield; United Kingdom
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29
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Abstract
Many episodic phenomena involving motor, sensory, autonomic, and behavioral functions may imitate epilepsy. The aim of this article is to focus on the various manifestations and the diagnostic and therapeutic challenges of the most common of these disorders, as well as their relationship to emotional aspects. Syncope is caused by reduced global cerebral perfusion. Convulsive movements are sometimes released from subcortical structures, but do not follow the characteristic sequence of tonic-clonic seizures, and postictal symptoms are minimal. Hyperventilation attacks are caused by the metabolic consequences of hypocapnia. Altered blood pH and cerebral vasoconstriction may cause a range of peripheral and central nervous system symptoms. Psychogenic non-epileptic seizures (PNES) are attacks of reduced self-control associated with various behavioral phenomena, usually beyond voluntary control. A detailed clinical history is the most important tool in the differential diagnosis. Various emotional factors may act as immediate triggers in reflex syncope and hyperventilation attacks, whereas in PNES, emotional traumas may be remote and suppressed. Patient education with appropriate explanation of the underlying mechanisms is a fundamental part of the management of these disorders.
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Affiliation(s)
- E Brodtkorb
- Department of Neuroscience, Norwegian University of Science and Technology, NTNU, Trondheim, Norway.
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